Common Questions

About Breastfeeding

Why Breastfeed?
Breast milk is the only food your baby needs until about six months of age. Research shows that breastfeeding has many
health benefits for both the baby and mother.

Baby Benefits of Breastfeeding

Decrease your baby’s risk of:
• Ear infections
• Asthma
• Eczema due to allergies
• Vomiting and diarrhea illness
• Being hospitalized for wheezing and pneumonia during the first year of life
• Getting Type I or II Diabetes
• Acute lymphocytic leukemia and acute myelogenous leukemia (two types of childhood cancer)
• Sudden Infant Death Syndrome
Mother Benefits of Breastfeeding
Decrease the mother’s risk of:
• Developing Type II Diabetes
• Premenopausal breast cancer
• Ovarian cancer
Additional benefits:
Breastfed children have fewer health complications than formula-fed children. You will save money due to fewer missed
days of work, trips to the clinic, and copays for clinic visits and prescriptions for your sick child.

How Often and How Much Do I Need to Breastfeed?

When a woman is pregnant, hormones help to keep her pregnant. One of these is called progesterone. Progesterone also
tells her breast to start getting ready to feed the baby. When the baby and all the placenta are delivered, progesterone
rapidly drops. Another hormone, called prolactin, quickly increases. Prolactin is highest when the baby is about two days
old. Prolactin triggers the woman’s body to make more milk.

Every time the woman nurses her baby or pumps her breasts she gets a small increase in prolactin. It is best to start
breastfeeding within one to six hours after birth. Usually a newborn baby will nurse about 8 to 12 times in a 24-hour
day. This works out to be about every one to three hours. Breastfeeding often tells the breast of the woman to increase
how much milk is made. This will make sure that there is a lot of milk several months after birth. Usually, the baby gets
about 15 ml (1/2 ounce) at a feeding when three days old. By four days of age the baby gets about 30 ml (1 ounce) per
feeding. On the fifth day the baby gets about 45 ml (1 ½ ounces) per feeding.
By two weeks of age the baby is getting 480 to 720 ml (16 to 24 oz.) per day. By one month of age the baby is getting 750
to 800 ml of breast milk per day. Some babies will eventually get large volumes, 3 – 5 oz. per feeding. These babies will
probably nurse less often. Other babies will continue to get small volumes and will continue to need to nurse often. Both
babies are normal and will grow well.

By the third day of life, your baby usually will get about a tablespoon (15 ml) at each feeding. This is a small volume but
it is normal and expected. Your baby seems to know that the milk supply is increasing. Babies tend to nurse almost
continuously on the third night after birth. This continuous breastfeeding will stop as your milk supply increases.

How Long Should a Feeding Take?

Initially, breast feedings tend to be longer—about 20 minutes per breast. In the first days of life the amount of milk
in both breasts is small. It is important for babies to breastfeed on both breasts if possible. At HealthPartners Como
Breastfeeding Center we recommend that you watch your baby’s cues. Cues are those little behaviors that your baby does
to help you know them. A baby cue may be starting to fall asleep or increased squirming. Take the baby off the breast
at this point. Offer them the chance to burp and then change sides. Sometimes you will find that after nursing on both
breasts your baby needs to relatch to the first breast. This extra breastfeeding should help your baby be satisfied. Your
breast is always making milk. You never empty completely.

After 40 minutes of breastfeeding, we encourage you to take a half-hour break. Try to console your baby in another
manner. When your baby nurses again, you will get another surge of the make milk hormone, prolactin.
As your baby gets older they may shorten how long a feeding lasts. Some babies will get 60 to 150 ml (2 – 5 ounces) in
five minutes time. However, some babies continue to take 20 to 40 minutes per feeding. Both types of babies are normal.

What is Colostrum?
A nursing mother’s first milk for baby is called colostrum. This is food, just like later milk. It is protein (like steak or
dried beans). Colostrum contains minerals and water and is made just for your baby. It contains things that help protect
your baby from illness. Colostrum helps to get the gut ready for other solid foods. We call it liquid gold because you can’t
easily buy it. It comes in small amounts usually, milliliters or teaspoons. Colostrum is only available for a few days. If your
baby is not breastfeeding, you can usually get more colostrum if you hand express your breast.

Do I Need to Use a Nipple Shield?

Nipple shields can help babies latch, stay latched, and re-latch quickly. The nipple shield can help women and infants
continue to breastfeed when they would otherwise have quit by decreasing the pain associated with breastfeeding when
nipples are damaged. When you use a nipple shield, there is an increased risk of having a decreased milk supply. To help
prevent this, we reccomend you pump both breasts three to four times per day after breastfeeding.

Typical mom reasons for using a nipple shield

• Flat or inverted nipples
• Sore, cracked, and painful nipples
• Breast engorgement (fullness)
• Too much milk
Typical baby reasons for using a nipple shield
• Hard time latching or staying latched (can be related to prematurity)
• Receding chin
• Hard time sucking
• Changing from bottle to breast
If your baby is having trouble breastfeeding, schedule an appointment with a breastfeeding consultant. We’ll help you to
find out if a nipple shield is right for you.

How Do I Use a Breast Pump?

1. Wash your hands and set up your pump on a clean surface. A clean towel or placemat is good place to set up
your equipment.
2. Apply warmth to the breast for a few minutes while you set up your pumping equipment. Use a hand towel
soaked in warm water, then wrung out. This can help increase blood flow to the breast and improve let down.
3. Massage your breasts. This increases how much milk you can pump and increases the calories in your milk.
4. Practice relaxation breathing. This may also help increase how much milk you can pump.
5. Pump both breasts at the same time. This helps women get more milk than pumping one breast at a time. It
also takes much less time. Note when your milk stops flowing and pump for 1 – 2 more minutes.
6. Then, change your breast pump to single pumping set up. Pump one breast. Hold the flange against the
breast with one hand and massage and squeeze the same breast with the other hand. You will find areas where the
pressure of your fingers and hand causes the milk to flow again. Work your way around both breasts until milk no
longer flows. This technique helps you empty your breast well and better maintain your milk supply.
7. When you are done pumping, wash your hands again and clean your pump equipment. If you see moisture in
the tubing, the tubing needs to be replaced or washed. Attach the tubing to the pump and run the pump to dry the
tubing. Take apart the pump kit and rinse all parts with cool water to get all milk off the pieces. Then wash them
in warm soapy water. Rinse thoroughly and dry with a clean paper towel. If you do not have time to go through all
these steps, rinse the pumping equipment and clean it more thoroughly later. Pump kit pieces can also be cleaned
in the dishwasher.

How Do I Store My Breast Milk?

Breast milk is best stored in glass or BPA-free hard plastic baby bottles. Avoid plastic with number 3 or 7 on the bottom.
You can also use clean food storage containers such as canning jelly jars. Polyethylene bags may be used for milk storage.
Storage bags should be double bagged in the freezer to help protect the milk. More milk fat and secretory IgA (calories
and germ fighting properties) will be lost when storing breast milk in bags. The storage containers do not need to be
sterile, but they do need to be clean and dry. Containers should be closed with solid lids and not with baby-bottle
nipples.

Don’t fill the storage container more than three-fourths full. There must be room for the milk to expand without
breaking the container. Do not store expressed breast milk in the door of the refrigerator or freezer. The temperature
will be less stable there. Refrigerator temperatures should be are 35–40 0F (1-40C). Freezer temperatures should be –4 0F
(-20 0C) or below.

When Are Common Growth Spurts?

Babies will have times when they nurse much more frequently. When this happens your breasts may feel very soft. You
might worry that you have no milk. The baby is telling the woman’s body that they need more. In a few hours to days
your body will make more milk. The baby will go back to breastfeeding as frequently as they were before. Common times
for these growth spurts are two to three weeks of age, six weeks, three months and six months of age.
Do Pacifiers Mess Up Breastfeeding?
Using a pacifier may be related to shorter breastfeeding. Using a pacifier may be sign of breastfeeding problems. One
good study called women on the phone to see how often they used a pacifier. The women in this study also kept a diary of
when they used a pacifier. This study found that using the pacifier did not harm breastfeeding. However, using a pacifier
did not help the babies cry less. If you are already give your baby a bottle sometimes, using a pacifier typically will not
decrease how long you breastfeed.

Pediatricians suggest that you wait to use a pacifier until after the first month. Breastfeeding should be well established
at this point. However, no one knows you, your baby, your family, or your goals as well as you do. You may feel you need
to use a pacifier to get a break from breastfeeding. Taking this break may help you to breastfeed longer.

Pacifiers can have some benefit. Babies are less likely to die of Sudden Infant Death if they use a pacifier as they go to
sleep. You do not need to put the pacifier back in your baby’s mouth when they spit it out. Premature infants who suck
on a pacifier become stronger feeders.

If you have any questions, concerns, or would simply like more information, please schedule an appointment
with a breastfeeding consultant by calling (952) 967-7955.
 References

American Academy of Pediatrics. (2005). The changing concept of sudden infant death syndrome:
Diagnostic coding shifts, controversies regarding the sleeping environment, and
new variables to consider in reducing risk. Pediatrics, 116(5),
1245-1255.doi:doi:10.1542/peds.2005-1499

Ball, T. M., & Bennett, D. M. (2001). The economic impact of breastfeeding. Pediatric Clinics of North
America, 48(1), 253-262.

Bartick, M., & Reinhold, A. (2010). The burden of suboptimal breastfeeding in the united states: A
pediatric cost analysis. Pediatrics, 125(5), e1048-e1056. Retrieved from
http://pediatrics.aappublications.org/content/125/5/e1048.full.html

Chertok, I. R. (2009). Reexamination of ultra-thin nipple shield use, infant growth and maternal
satisfaction. Journal of Clinical Nursing, 18, April 22, 2011. doi:10.1111/j.1365-2702.2009.02912.x

Czank, C., Henderson, J. J., Kent, J. C., Lai, C. T., & Hartmann, P. E. (2007). Hormonal control of the
lactation cycle. In T. W. Hale, & P. E. Hartmann (Eds.), Textbook of human lactation
(First ed., pp. 89-111). Amarillo, TX: Hale Publishing.

Daly, S. E., Owens, R. A., & Hartmann, R. E. (1993). The short-term synthesis and infant-regulated
removal of milk in lactating women. Experimental Physiology, 78(2), 209-20. Retrieved from
http://ep.physoc.org/content/78/2/209.full.pdf+html

De Carvalho, M., Robertson, S., Friedman, A., & Klaus, M. (1983). Effect of frequent breast-feeding on
early milk production and infant weight gain. Pediatrics, 72(3), 307. Retrieved from
http://pediatrics.aappublications.org.ezp2.lib.umn.edu/content/72/3/307

Eglash, A., Ziemer, A. L., & Chevalier, A. (2010). Health professionals’ attitudes and use of
nipple shields for breastfeeding women. Breastfeeding Medicine, 5(4), 147-152.
doi:10.1089/bfm.2010.0006

Feher, S. D., Berger, L. R., Johnson, J. D., & Wilde, J. B. (1989). Increasing breast milk production for
premature infants with relaxation/imagery audiotape. Pediatrics, 83(1), 57-60

Hale, T. W., & Hartmann, P. E. (2007). Textbook of human lactation (First ed.). Amarillo, TX: Hale
Publishing Hartmann, P. E., Trevethan, P., & Shelton, J. N. (1973). Progesterone and oestrogen
and the initiation of lactation in ewes. Journal of Endocrinology, 59, 249-259

Hauck, F. R., Omojokun, O. O., & Siadaty, M. S. (2005). Do pacifiers reduce the risk of sudden infant
death syndrome? A meta-analysis. Pediatrics, 116(5), e716-e723. doi:10.1542/peds.2004-2631

Howard, C. R., Howard, F. M., Lanphear, B., Eberly, S., deBlieck, E. A., Oakes, D., & Lawrence, R.
(2003). Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their
effect on breastfeeding. Pediatrics, 111(3), 511-518. doi:10.1542/peds.111.3.511
 References (continued)

.Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., . . . Lau, J. (2007). Breastfeeding and
maternal and infant health outcomes in developed countries. (Evidence Report/Technology
Assessment No. 07-E007 April). Boston, MA: AHRQ Publication. Retrieved from
http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf

Jones, F. (2011). Best practice for expressing, storing and handling human milk is hospitals, homes,
and child care settings (3rd ed.). Fort Worth, TX: Human Milk Banking Association of
North American, Inc.

Josimovich, J. B., Reynolds, M., & Cobo, E. (Eds.). (1974). Problems of human reproduction (2nd ed.).
New York: John Wiley & Sons.

Kramer, M. S., Barr, R. G., Dagenais, S., Yang, H., Jones, P., Ciofani, L., & Jane, F. (2001). Pacifier use,
early weaning, and cry/fuss behavior: A randomized controlled trial. Journal of the American
Medical Association, 286(3), 322-326. doi:10.1001/jama.286.3.32

Kuhn, N. J. (1969). Projesterone withdrawal as the lactogenic trigger in the rat. Journal of
Endocrinology, 44, 38-42

Morton, J., Hall, J. Y., Wong, R. J., Thairu, L., Benitz, W. E., & Rhine, W. D. (2009). Combining hand
techniques with electric breast pumping increases milk production in mothers of preterm
infants. Journal of Perinatology, 29(11), 757-764. doi:10.1038/jp.2009.87

Neville, M. C., McFaddin, T. B., & Forsyth, I. (2002). Hormonal regulation of mammary
differentiation and milk secretion. Journal of Mammary Glandular Biology and Neoplasia,
7(1), 49-66.

Powers, D., & Tapia, V. B. (2004). Women’s experiences using a nipple shield. Journal of Human
Lactation, 20(3), April 22, 2011. doi:10.1177/0890334404267214

Saint, L., Smith, M., & Hartmann, P. E. (1984). The yield and nutrient content of colostrum and milk
of women from giving birth to 1 month post-partum. British Journal of Nutrition, 52(1),
April 13, 2011. doi:10.1079/BJN19840074

Standley, J. M. (2003). The effect of music-reinforced nonnutritive sucking on feeding rate of

premature infants. Journal of Pediatric Nursing, 18(3), 169-173. doi: 10.1053/jpdn.2003.34

Tyson, J. E., Khojandi, M., Huth, J., & Andreassen, B. (1975). The influence of prolactin secretion on
human lactation. Journal of Clinical Endocrinology Metabolism, 40(5), 764-773